Human Lymphadenopathy Caused by Ratborne Bartonella, Tbilisi, Georgia.

Lymphadenopathy and fever that developed in a woman in Tbilisi, Georgia, most likely were caused by a ratborne Bartonella strain related B. tribocorum and B. elizabethae. The finding suggests that this Bartonella strain could be spread by infected rats and represents a potential human risk.

Surveillance of bacterial meningitis in the country of Georgia, 2006-2010.

Bacterial meningitis remains important cause of morbidity and mortality worldwide, particularly in developing countries. This study analyzed the data from sentinel surveillance for bacterial meningitis among children <5 years of age hospitalized in largest children's hospital in Tbilisi, capital of Georgia and adult patients hospitalized in infectious diseases hospital during 2006-2010 with suspected bacterial meningitis. The surveillance is conducted by National Center for Disease Control and Public Health (NCDCPH). The number of patients with identified organism was 127 (19 %). In the subsample of patients with laboratory confirmed bacterial meningitis Streptococcus pneumoniae was the most frequently isolated organism (67 cases, 52.8 %), followed by. influenza (17 cases, 13.4 %) and Neisseria meningitidis (16 cases, 12.6 %). The number of patients with suspected TB meningitis was 27 (21.3 %). The overall case fatality rate in the subgroup of patients with identified organism was 12.3 %. The highest mortality was observed among TB patients (22.2 %) with 14.3 % mortality for N. meningitidis and 10.3 % for S. pneumoniae. No lethal outcome was observed among patients with Haemophilus influenzae.

Influenza-associated mortality in georgia (2009-2011).

We analyzed data from NCDCPH Georgia where samples from outpatients with influenza-like illness (ILI) and inpatients with severe acute respiratory syndrome (SARI) are referred for testing on influenza virus using PCR analysis. During 2009-2010 and 2010-2011 influenza pandemics total number of the laboratory-confirmed influenza cases were 1286 with 33 deaths (all of them influenza type A) and 1203 (51.4% type A) with 44 deaths, respectively. At least one underlying medical condition was reported in 70.7% (for pandemic influenza strain) and 96% (for influenza type B) of deaths. Predominating preexisting condition was coronary heart disease.

Elimination of malaria in country Georgia.

Malaria is well known in Georgia since ancient times, causing national disasters with associated significant mortality and economic losses. By 1970 Georgia managed to reach complete and sustained elimination of the disease as a result of comprehensive anti-malaria measures undertaken in the country. However from the mid-1990s, economic collapse following disintegration of Soviet Union causing breakdown of important public health networks including anti-malaria preventive and control infrastructure resulted in gradual increase of malaria cases in the country with a peak of 437 and 474 cases in 2001 and 2002, respectively. From 2000 two major anti-malaria efforts were carried out by National Center for Disease Control and Public Health, WHO and Global Fund to Fight AIDS, tuberculosis and malaria and as result of comprehensive and collaborative work in 2010 the level of zero cases of local mosquito-borne malaria transmission was achieved and the country entered the elimination phase.

Circumstances surrounding the community needle-stick injuries in Georgia.

Community needle-stick injuries are important public health problem due to concern of blood-borne pathogen transmission. Purpose of this study was to describe circumstances related to non-occupational needle-stick injuries in Georgia. Data were collected from one outpatient clinic in Tbilisi. Medical records from 2002 to 2007 were reviewed. Blood tests were performed on HBV, HCV and HIV at first visit and 6 months after exposure. 25 (54.4%) study subjects were children playing in street/yard and being accidentally stuck by used needle. Most frequent circumstances related to needle stick among adult individuals were recapping or discarding used needle while taking care of family member needed home injections (12 cases). Eight participants (17.4%) reported accidentally stepping on used needle at sea shore. No infection with HIV and HCV were documented. Only one case of HBV infection occurred in female patient taking care of mother with chronic HBV infection. Study suggests that seroconversion for blood-borne infections after community needle-stick injuries is very low. Family members of patients receiving home injections should be informed about potential risks and advised using infection-control measures. Parents/teachers should be educated about the circumstances related to exposure to used needles among children.

Destructive osteomyelitis associated with early secondary syphilis in an HIV-positive patient diagnosed by Treponema pallidum DNA polymerase chain reaction.

A 20-year old man who had sex with men (MSM) presented with destructive osteomyelitis of the sternal bone and diffuse maculopapular rash. During laboratory evaluation he was found to have secondary syphilis and HIV with viral load of 28,000 copies per milliliter and CD4 count of 251 cells per microliter. Surgical debridement and biopsy of the sternal bone was performed. The biopsy examination demonstrated bone necrosis with perivascular infiltration of plasma cells and lymphocytes and rare hystiocytes. No granulomatous lesions were identified and acid-fast, fungal, silver, and Gram's stains did not show any organism. All cultures were negative. Real-time polymerase chain reaction (PCR) using probes targeting a pathogen-specific and highly conserved TpN47 gene of Treponema pallidum was performed on the DNA, extracted from the biopsy specimen and T. pallidum amplicons were detected. Patient was initially treated empirically with vancomycin, piperacillin/tazobactam and intravenous aqueous penicillin G. After confirming the diagnosis he completed 2 weeks of intravenous aqueous penicillin G treatment with resolution of osteomyelitis confirmed at follow-up visit after 6 weeks. Osteomyelitis is a rarely described manifestation of secondary syphilis. To the best of our knowledge, this is the first case of using T. pallidum DNA PCR to confirm the diagnosis of syphilitic osteitis. We suggest that osteomyelitis may be an underrecognized problem in patients with secondary syphilis, especially in HIV-coinfected individuals and PCR seems to be a valuable method in confirming the diagnosis.